Catheter



Jan 28, 1964 KARL-LUDWIG zr-:lss 3,119,392

CATHETER Filed Feb. 14. 1961 3 Sheets-Sheet 1 Jam 28, 1964 KARL-LUDWIGzElss 3,119,392

CATHETER Filed Feb. 14, 1961 3 Sheets-Sheet 2 IN2/enfer Kar-I wzay zeissma@ MVM United States Patent O 1 3,119,392 CATEETER Karl-Ludwig Zeiss,deceased, late of Bad Wildungen, Germany, by Ali-ce Zeiss. Karl-nudwgZeiss, and Martin Zeiss, all of Riehard-Kirchner-Str. 33, Bad Wildungen,Germany; Peter Zeiss, Dr.B0m-Str. 7, Bad Wildungen, German g WiltrudGeise, nee Zeiss, Speisingerstr. 73, Vienna, Austria; and Ellie Zeiss,Kratzerstr. 33, Munich, Germany, heirs Filed Feb. 14, 1961, Ser. No.89,319 6 Claims. (Cl. 12S-32S) This invention relates to a catheter, andmore particularly to a catheter having a loop for the removal of stoneslocated in the ureter.

A loop catheter consists of a exible catheter tube which has a threademerging from the front end thereof which enters the catheter tubethrough a hole a few centimeters behind the front end of the tube. Thethread then extends inside the tube and comes out of the back end of thetube. If one holds the back end of the tube firmly and pulls out a pieceof the thread, then a loop is formed by the catheter tube at the frontend of the tube.

A kidney stone which is located in the ureter may be removed in thefollowing manner. First, one nds out by means of an X-ray picture where`the stone is located in the ureter. Then a cystoscope is inserted intothe bladder of the patient. A conventional urinary duct catheter isinserted through the cystoscope and introduced into the ureter. Theurinary duct catheter is moved up inside the ureter until it has passedthe stone. Next, another X-ray picture is taken to determine on whichside of the catheter the stone is located. The urinary duct catheter isthen removed, and the loop catheter is inserted into the ureter. Itpasses the stone in most cases at the same side as the urinary ductcatheter. The loop catheter must be inserted into the ureter in such away that the loop formed is in the direction of the stone, or in otherwords, the entrance opening must confront the stone while the front endof the catheter is guided past the stone. The loop does not develop inthe form of a tennis racket, whose lateral expansions are both of equalsize, but it always develops asymmetrically and only toward the side ofthe catheter where the entrance opening for the thread is located. Theloop is formed above the stone and pulled downward. While doing this,the stone is pressed from the Walls of the ureter into the loop and heldin the loop. By pulling the loop from the ureter, the stone is pulledOut.

t is ditlicult to insert a loop catheter into the ureter with the properorientation relative to the stone, and often several attempts arerequired. Even if one had introduced the catheter into the cystoscopewith the correct orientation, and also made sure in the cystoscope-opticsystem that the loop thread at the front end of the catheter had thecorrect position when inserted into the ureter, involuntary twisting ofthe catheter during further upward movement cannot be avoided. This isthe case especially when the catheter must be moved very high inside theureter, namely up to the kidney region or even into the pelvis of thekidney and into the kidney calyx. In such cases, a distance of up to 32centimeters must be traversed from the opening of the ureter into thebladder.

lt is an object of the present invention to provide a loop catheter withmeans for facilitating insertion of the catheter into the ureter withthe proper orientation.

More specifically, it is an object of the present invention to provide aloop catheter with indicia which may be visually observed to insert thecatheter into the ureter at the proper angular orientation to the stoneto form a loop which will engage the stone.

In accordance with the invention, the loop catheter is provided with atleast one straght longitudinal stripe parallel to the axis of .thecatheter, which is visible from the exterior of the catheter and is of acolor contrasting With the color of the catheter tube. As a result, itis possible for the attending physician to control the cystoscopecontinuously while it is pushed in, so that the catheter does not turnfrom its desired position. Furthermore, when the catheter tube is pushedin afterwards, checking can be carried out which, up to now, had notbeen possible. The longitudinal stripe of the catheter tube maybeobserved inside the urinary bladder through the optic system of thecystoscope. Thus, care can be taken continuously so that the cathetertube is pushed into the ureter in a correct position. As a result,twisting of the catheter as it moves from the outer end of thecystoscope to the entry into the ureter is avoided. This distance isapproximately 30 centimeters, or about the same length as the largestdistance to be covered in the ureter itself.

Further objects and advantages of the invention will be apparent fromthe following description, particularly when viewed in connection withthe drawings, in which:

FIGURE 1 is a longitudinal sectional view of a loop catheter constructedaccording to the present invention and shown extended, the width of thecatheter being enlarged more than the length;

FIGURE 2 is a longitudinal section of the front end of the same catheterafter formation of the loop;

FIGURE 3 is an elevational view of the front end of the loop catheter ofFGURES 1 and 2;

FIGURE 4 is an isometric view of the front end of another embodiment ofthe invention employing a tilted loop catheter, the view illustratingthe tilted loop;

FlGURE 5 is a sectional View of the front end of the catheter of FIGURES1 through 3 taken along the line 5--5 of FlGURE 3;

FlGURES 6 and 7 are sectional views similar to FIG- URE 5 showingalternate constructions in accordance with the invention; and

FGURE 8 is a schematic elevational View of a cystoscope with a catheterof the type illustrated in FIGURES l and 2 extending therethrough.

In FlGURES l and 2, the front end of a loop catheter is shown insection. The catheter tube 1 is made of silk hose saturated with lacquerso that a exible catheter tube results which is smooth on the outsideand which, in spite of its flexibility, is stiff enough Ito be pushedforward in the ureter. The exterior diameter of the catheter tube, forinstance, is 1.8 millimeters. A strand of thread 2 runs inside the tubefor the entire length of the rear part of the catheter wlmich is notshown, and it emerges laterally through a slanted opening 3 and then itextends for about 3 to 8 centimeters outside of the tube and enters thetube again at the tip 4 of the tube. The tip has only a very thinchannel 14 through which the thread passes to the interior of the tube.A knot 5, which is formed by thread 2, secures the thread againstslipping out through the channel. The thread 2 runs beyond the knot 5,and is secured to an elastic insert member 6 which is snugly disposed inthe catheter tube. The insert 6 is in the form of a hollow tube 6 whichis snugly disposed within the catheter tube 1 and has an aperture 6 atits forward end for engaging the thread 2. The tube 6 also has aflexible filler body '7 centrally therein. It is the task of this member6 to hold the loop in the ureter in a spread condition against thepressure of the ureter Walls.

The lacquer of the catheter tube 1 contains a barium or `lead compoundso that the catheter tube thereby gives a good shadow in an X-raypicture. Furthermore, a centimeter scale in form of colored rings 1(FIGURES 3 and 4) is disposed on the exterior of the tube and extendsabout the tube in a plane normal to the axis thereof.

In accordance with the invention, a longitudinal stripe '7, preferablyred, is applied on the outside of the catheter tube parallel to the axisof symmetry of the tube. The stripe 7 extends over opening 3, and,without twist, to the rear end of the catheter tube. Two additionallongitudinal stripes S and 9 of a different color are arranged onopposite sides of the stripe 7 and each of these stripes is displacedfrom the stripe 7 by 90 degrees. In FIGURE 3, only one of theseadditional stripes 8 can be seen which, for instance, may be blue. Theother longitudinal stripe 9, which is visible in FIGURE 5, may, forinstance, be green.

If it is desired to form the loop toward the front, then it is necessaryonly to keep the red stripe '7 in constant View during introduction intothe cystoscope. However, if one keeps the blue longitudinal stripe S inview, then the loop forms toward the left. If one has the greenlongitudinal stripe 9 in View, then the loop forms toward the right. 1fone has no stripe at all in view, then the loop forms toward the rear(dorsally). Preferably, the stripe is made narrow in comparison to thediameter of the catheter.

In addition to the mentioned simple loop catheters, the invention isalso applicable to tilted loop catheters in which a first thread isprovided for the formation of a simple loop and, in addition to it, asecond thread is provided for twisting the loop. The second thread,designated l in FXGURE 4, is secured near the upper end of the cathetertube and then extends for a distance outside of the catheter tube. Thesecond thread lli enters the tube laterally through an opening lll'which is located on the side of the opening 3 for the thread of thesimple loop remote from the end, and the opening ll is angularlydisplaced from the opening 3 by 90 degrees relative to the axis of thetube. As a result, a simple catheter loop in the ureter may be tilted,and thus moved to a transverse position. Such tilted loops are used whenelongated or perhaps symmetrical stones are located in the ureter in alongitudinal direction causing a simple loop to slip off. The loop of atilted loop catheter is brought into its tilted position above such astone, pulled toward the stone so that it reaches over one end of thestone, and then pulled out -with the stone. With such catheters, theattending physician must know the direction which the simple loop has tobe tilted, since, Iafter tilting, the entire loop formation pointstoward this side.

FIGURE 4 shows the arrangement of Ithe longitudinal stripes inconnection with a tilted loop catheter. Here, a simple loop similar tothe loop of FIGURE 2 is in addition put -in a transverse position ortilted by the special tilting thread l0. Since, in connection with thisloop, the tilting direction is especially important, the middle, i.e.the red, stripe 7 4runs past the entry opening lll of the tiltingthread. The blue stripe 8, turned by '90 degrees counterclock-wise inrelation to the red stripe, runs through the opening 3. The green stripe9 is turned by 180 degrees in relation to the blue stripe 8.

In order to save expenses, a single Wide stripe lll (FIG- URE 6) may beused in place of the three stripes of different color; this stripecovers 180 degrees of the circumference of the catheter tube l. Whensuch a catheter is introduced, the physician must be careful that, inaccordance with the direction in which the loop should form, he eithersees the color stripe in its entire width or no stripe at all, or thathe sees the right or the left edge of the stripe. It is true, thisarrangement of the color stripe is cheaper than the arrangement of threecolor stripes in accordance with FIGURE 5, however, it will causesomewhat less exact work, especially if one has to tilt the loop forwardand therefore must pay attention to the center of the color stripe.

An arrangement which is somewhat improved in comparison to FIGURE 6 is,therefore, shown in FIGURE 7, Where two spaced color stripes 12 and 13of the same color are illustrated. Between the two color stripes, a verysmall stripe is formed by the basic color of the catheter tube. Thisstripe passes through the entry opening for the loop thread 2 or theopening Ifor the tilted loop thread. The reverse side of the tube (theentire degrees) is again not covered by the color stripe.

The color stripes 7, S, 9, lll, l2 or i3 may be applied to the .alreadyfinished catheter tube by means of a special durable paint. Thisprocedure is inexpensive, however, part of the color stripe may bescraped off occasionally by a stone. Preferably, the stripe is workedinto the lacquer during the manufacturing of the catheter tube so that amassive piece of color forms part of the tube Wall. If part of thiscolor material is scraped off, the color stripe remains visible,nevertheless.

It is preferable to apply the longitudinal stripes first, and then thecross rings l of the centimeter scale, especially on longitudinal stripetypes in accordance `with FIGURES 6 and 7, so that the centimeter scalemay be recognized well in each position of the longitudinal stripes.

FIGURE 8 illustrates a cystoscope with a loop catheter slideablydisposed therein and extending from both ends of .the cystoscope. Thecystoscope is generally indicated by the reference numeral 2l, and has atube Z3 which eX- tends therethrough for viewing the interior of acavityr of a patient. The tube 23 extends from a viewer 25 which isdisposed exterior of the patient in use and may be referred to as theouter end of the cystoscope. The opposite end of the tube 23 may bereferred to as the inner end of the cystoscope, and it terminates at 24.A lamp Z7 is disposed at the inner end of the cystoscope to illuminatethe cavity of the patient for viewing purposes. The tube 1 of thecatheter is illustrated as disposed within the channel 29 and extendingfrom the inner end of the cystoscope. It is to be noted that thereference numerals applied .to the catheter correspond to those shown inFIGURES 1 through 3.

From the foregoing disclosure, those skilled in the art will readilydevise many modifications to the structure here set forth, and manyaddition-al applications of the present invention. It is, therefore,intended that the scope of the invention be not limited by the foregoingdisclosure, but rather only by the appended claims.

The invention claimed is:

l. A device for removing stones in the ureter of a patient comprising acystoscope having an exterior end adapted to be disposed exterior of thepatient and an interior end adapted to be disposed Within the bladderofthe patient for viewing the interior of the bladder, said cystoscopehaving a channel extending from the exterior to the interior endsthereof, and a catheter having a hollow flexible tube slideably disposedwithin the channel of the cystoscope and extending from both ends of thecystoscope, said catheter being of sufficient length to extend from theinterior end of the cystoscope through the bladder and ureter of thepatient to .the kidney of said patient, said tube having an axis ofelongation land an opening therein spaced from one end thereof, a threadof greater flexibility than the tube secured at one end to said one endof the tube and entering the tube through the opening thereof, saidthread extending slidably within the tube and from the other end of thetube for forming the portion of the tube adjacent to said one end of thetube into a loop by tensioning the thread, means disposed within thetube located between said one end of the tube and the opening forpreventing collapse of this portion of the tube, said means comprisingan elastic insert disposed within the tube and abutting the surfacethereof, and a stripe of a different color than the tube extending alongthe exterior surface of the tube parallel to the axis of elongation ofthe tube for the entire length of the tube, said stripe being at a knownorientation relative to the aperture in the tube, whereby the tube maybe inserted into the ureter by manipulating the tube exterior of thepatient and the rotational position of the tube in the ureter controlledat the mouth of the ureter by viewing the location of the stripe at themouth of the ureter through the optical system of the cystoscope for thepurpose of locating the loop of the catheter relative to the position ofthe stone.

2. A device for removing stones in the ureter of a patient comprisingthe elements of claim 1 wherein the tube is provided with `a secondopening disposed on a radius of the tube angularly displaced from theradius of the irst opening and on the opposite side of the first openingfrom said one end of the tube, and in combination with a second threadsecured to the tube between the rst opening and said one end of the tubeand extending exterior of the -tube to the second opening, through thesecond opening, and slideably along the interior of the tube away fromsaid one end of the tube.

3. A device for removing stones in the ureter of a patient comprisingthe elements of claim 1 wherein the stripe is narrow compared to thecircumference of the catheter and extends over the 4opening in the tube.

4. A device for removing stones in the ureter of a patient comprisingthe elements of olaim 1 wherein a second stripe of a diierent color thanthe first stripe is disposed on the exterior surface of the tubeparallel `t0 and spaced from the rst stripe.

5. A device for removing stones in the ureter of a patient comprisingthe elements of claim 1 in combination with a second and a third stripeparallel and equally spaced from the trst stripe, the second and thirdstripes being on opposite sides of the first stripe and each stripebeing on opposite sides of the first stripe and each stripe being of Iadifferent color than the other stripes.

6. A device for removing stones in the ureter of a patient comprisingthe elements of claim 1 in combination with a second stripe of adifferent color than the tube parallel to the rst stripe, the rst andsecond stripes being on opposite sides of the opening and equally spacedtherefrom, said irst and second stripes being on the same half of thetube and each having one edge on an axial plane of the tube.

References Cited in the le of this patent UNITED STATES PATENTS1,303,135 Wapp'ler May 6, 1919 1,920,006 Dozier July 25, 1933 2,118,631Wappler May 24, 1938 2,753,869 Mufy July 10, 19'56 2,857,915 SheridanOct. 28, 1958 FOREIGN PATENTS 15,231 Great Britain Aug. 15, 1896 19,285Great Britain Sept. 27, 1901 721,166 France Dec. 12, 1931 834,690 FranceAug. 29, 1938

1. A DEVICE FOR REMOVING STONES IN THE URETER OF A PATIENT COMPRISING ACYSTOSCOPE HAVING AN EXTERIOR END ADAPTED TO BE DISPOSED EXTERIOR OF THEPATIENT AND AN ELONGATION OF THE TUBE FOR THE ENTIRE LENGTH OF THE TUBE,SAID STRIPE BEING AT A KNOWN ORIENTION RELATIVE TO THE APERTURE IN THETUBE, WHEREBY THE TUBE MAY BE INSERTED INTO THE URETER BY MANIPULATINGTHE TUBE EXTERIOR OF THE PATIENT AND THE ROTATIONAL POSITION OF THE TUBEIN THE CONTROLLED AT THE MOUTH OF THEURETER BY VIEWING THE LOCATION OFTHE STRIP AT THE MOUTH OF THE URETER THROUGH THE OPTICAL SYSTEM OF THECYSTOSCOPE FOR THE PURPOSE OF LOCATING THE LOOP OF THE CATHETER RELATIVETO THE POSITION OF THE STONE.